title: Transapical mitral valve-in-valve implantation: a novel approach guided by three-dimensional transoesophageal echocardiography.
abstract: Prosthesis deterioration rate, years after a previous surgical valve replacement, is rising. Usually, the standard management is reoperation, but for very high risk patients an alternative has arisen: the valve-in-valve approach. We present an 84-year-old Caucasian woman with a mitral bioprosthesis (Mosaic II, number 29) since 1994. Over the last few months the patient displayed worsening heart failure symptoms, until her current admission in NYHA III-IV functional class, because of a severely degenerated mitral prosthesis (severe regurgitation, severe pulmonary hypertension). The transapical access, conventionally used for transcatheter aortic valve implantation (Edwards SAPIEN THV 23) was chosen, guided by transoesophageal echocardiography (TOE) with a new three-dimensional (3D) probe. After the procedure, the mitral regurgitation completely disappeared, an appropriate valve opening was achieved (valve area >2 cm(2)) and the patient was discharged 6 days later, remaining well in the outpatient follow-up. Only a restricted number of patients have been submitted to mitral transcatheter valve-in-valve implantation and to the best of our knowledge this is the first accurate description of the 3D TOE part, focusing on the surgeon requirements.
authors.affiliation: Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain. ibnsky@yahoo.es
authors.forename: Iván J
authors.initials: IJ
authors.lastname: Núñez-Gil
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gonçalves
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez
authors.forename: Javier
authors.initials: J
authors.lastname: Cobiella
authors.forename: Pedro
authors.initials: P
authors.lastname: Marcos-Alberca
authors.forename: Luis
authors.initials: L
authors.lastname: Maroto
authors.forename: Covadonga
authors.initials: C
authors.lastname: Fernandez-Golfin
authors.forename: Manuel
authors.initials: M
authors.lastname: Carnero
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: José L
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D000369:Aged, 80 and over; D001705:Bioprosthesis / Q000009:adverse effects*; D006328:Cardiac Catheterization; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D018084:Ultrasonography, Interventional